MEDICARE: MR. MARK VOLLMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0005X	Critical Care Neonatal Nurse Practitioner	673534	TX

General Provider Information

NPI Number	:	1922061266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK VOLLMER

Provider Business Mailing Address
First Line	:	2511 BURLINGTON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-5322
Country	:	US
Telephone Number	:	214-769-9449
Fax Number	:

Provider Business Practice Location Address
First Line	:	2511 BURLINGTON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-5322
Country	:	US
Telephone Number	:	214-769-9449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/27/2010

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Directions to “ MR. MARK VOLLMER ” Practice Location

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